Exocrine Pancreatic Insufficiency

Key clinical point: Postoperative pancreas remnant volume was associated with the development of exocrine pancreatic insufficiency (EPI) after pancreatic resection.

Major finding: EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The incidence of EPI was higher in patients receiving Whipple vs. distal pancreatectomy (66% vs. 21%; P = .004). The only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% confidence interval, 0.88-0.98; P less than .01).

Study details: This study included 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45) at a single institution between 2017 and 2018.

Disclosures: No source of funding was identified.

Source: Johnston ME et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)02827-4.

Key clinical point: Postoperative pancreas remnant volume was associated with the development of exocrine pancreatic insufficiency (EPI) after pancreatic resection.

Major finding: EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The incidence of EPI was higher in patients receiving Whipple vs. distal pancreatectomy (66% vs. 21%; P = .004). The only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% confidence interval, 0.88-0.98; P less than .01).

Study details: This study included 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45) at a single institution between 2017 and 2018.

Disclosures: No source of funding was identified.

Source: Johnston ME et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)02827-4.

Key clinical point: Postoperative pancreas remnant volume was associated with the development of exocrine pancreatic insufficiency (EPI) after pancreatic resection.

Major finding: EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The incidence of EPI was higher in patients receiving Whipple vs. distal pancreatectomy (66% vs. 21%; P = .004). The only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% confidence interval, 0.88-0.98; P less than .01).

Study details: This study included 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45) at a single institution between 2017 and 2018.

Disclosures: No source of funding was identified.

Source: Johnston ME et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)02827-4.

Key clinical point: Considerable proportion of patients suffer from exocrine pancreatic insufficiency (EPI)-associated complaints which persisted for 3 years or even more after pancreatoduodenectomy or left pancreatectomy, even in patients receiving pancreatic enzyme replacement therapy (PERT).

Major finding: EPI, indicated by PERT usage, was reported in 41% of patients, of which only 48% reported complete relief, whereas 35% reported decrease in EPI-related complaints. Patients with vs. without PERT had higher complaints of fatty stools (50% vs. 26%; P = .003) and unintentional weight loss (11% vs. 2%; P = .019).

Study details: This study included 153 patients who underwent pancreatoduodenectomy or left pancreatectomy for premalignant or benign diseases between 2006 and 2016.

Disclosures: This study was supported by the Dutch Cancer Society. The lead author reported research funding from Mylan and Allergan.

Source: Latenstein AEJ et al. HPB. 2021 Apr 27. doi: 10.1016/j.hpb.2021.04.012.

Key clinical point: Considerable proportion of patients suffer from exocrine pancreatic insufficiency (EPI)-associated complaints which persisted for 3 years or even more after pancreatoduodenectomy or left pancreatectomy, even in patients receiving pancreatic enzyme replacement therapy (PERT).

Major finding: EPI, indicated by PERT usage, was reported in 41% of patients, of which only 48% reported complete relief, whereas 35% reported decrease in EPI-related complaints. Patients with vs. without PERT had higher complaints of fatty stools (50% vs. 26%; P = .003) and unintentional weight loss (11% vs. 2%; P = .019).

Study details: This study included 153 patients who underwent pancreatoduodenectomy or left pancreatectomy for premalignant or benign diseases between 2006 and 2016.

Disclosures: This study was supported by the Dutch Cancer Society. The lead author reported research funding from Mylan and Allergan.

Source: Latenstein AEJ et al. HPB. 2021 Apr 27. doi: 10.1016/j.hpb.2021.04.012.

Key clinical point: Considerable proportion of patients suffer from exocrine pancreatic insufficiency (EPI)-associated complaints which persisted for 3 years or even more after pancreatoduodenectomy or left pancreatectomy, even in patients receiving pancreatic enzyme replacement therapy (PERT).

Major finding: EPI, indicated by PERT usage, was reported in 41% of patients, of which only 48% reported complete relief, whereas 35% reported decrease in EPI-related complaints. Patients with vs. without PERT had higher complaints of fatty stools (50% vs. 26%; P = .003) and unintentional weight loss (11% vs. 2%; P = .019).

Study details: This study included 153 patients who underwent pancreatoduodenectomy or left pancreatectomy for premalignant or benign diseases between 2006 and 2016.

Disclosures: This study was supported by the Dutch Cancer Society. The lead author reported research funding from Mylan and Allergan.

Source: Latenstein AEJ et al. HPB. 2021 Apr 27. doi: 10.1016/j.hpb.2021.04.012.

Key clinical point: Over half of the patients with childhood-onset hereditary pancreatitis developed exocrine pancreatic insufficiency (EPI). EPI development preceded loss of endocrine function in this rare patient population.

Major finding: Overall, EPI developed in 7 patients at an average age of 12.5±8.4 years, with fecal pancreatic elastase less than 100 mg/g in all patients at disease onset. No evidence of pancreoprive diabetes mellitus (type IIIc) was reported in any patient.

Study details: This retrospective study evaluated 11 patients with childhood-onset (mean age at onset, 7.5±4.2 years) hereditary pancreatitis.

Disclosures: No funding source was identified. The authors declared no conflicts of interest.

Source: Prommer R et al. Wien Klin Wochenschr. 2021 Apr 28. doi: 10.1007/s00508-021-01869-0.

Key clinical point: Over half of the patients with childhood-onset hereditary pancreatitis developed exocrine pancreatic insufficiency (EPI). EPI development preceded loss of endocrine function in this rare patient population.

Major finding: Overall, EPI developed in 7 patients at an average age of 12.5±8.4 years, with fecal pancreatic elastase less than 100 mg/g in all patients at disease onset. No evidence of pancreoprive diabetes mellitus (type IIIc) was reported in any patient.

Study details: This retrospective study evaluated 11 patients with childhood-onset (mean age at onset, 7.5±4.2 years) hereditary pancreatitis.

Disclosures: No funding source was identified. The authors declared no conflicts of interest.

Source: Prommer R et al. Wien Klin Wochenschr. 2021 Apr 28. doi: 10.1007/s00508-021-01869-0.

Key clinical point: Over half of the patients with childhood-onset hereditary pancreatitis developed exocrine pancreatic insufficiency (EPI). EPI development preceded loss of endocrine function in this rare patient population.

Major finding: Overall, EPI developed in 7 patients at an average age of 12.5±8.4 years, with fecal pancreatic elastase less than 100 mg/g in all patients at disease onset. No evidence of pancreoprive diabetes mellitus (type IIIc) was reported in any patient.

Study details: This retrospective study evaluated 11 patients with childhood-onset (mean age at onset, 7.5±4.2 years) hereditary pancreatitis.

Disclosures: No funding source was identified. The authors declared no conflicts of interest.

Source: Prommer R et al. Wien Klin Wochenschr. 2021 Apr 28. doi: 10.1007/s00508-021-01869-0.

Key clinical point: Although locally advanced pancreatic cancer (LAPC) or metastatic pancreatic cancer (MPC) is associated with reduced exocrine function, there is a lack of clear guidelines for the diagnosis and management of exocrine pancreatic insufficiency (EPI) for palliative pancreatic ductal adenocarcinomas.

Major finding: Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively. Median body mass index decreased by 13.3% from preillness state to cancer diagnosis. Despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. Pancrelipase dose varied from 10,000 to 50,000 units with each meal.

Study details: This retrospective study assessed palliative management in 67 patients with LAPC or MPC.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Choi CCM et al. ANZ J Surg. 2021 Apr 18. doi: 10.1111/ans.16669.

Key clinical point: Although locally advanced pancreatic cancer (LAPC) or metastatic pancreatic cancer (MPC) is associated with reduced exocrine function, there is a lack of clear guidelines for the diagnosis and management of exocrine pancreatic insufficiency (EPI) for palliative pancreatic ductal adenocarcinomas.

Major finding: Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively. Median body mass index decreased by 13.3% from preillness state to cancer diagnosis. Despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. Pancrelipase dose varied from 10,000 to 50,000 units with each meal.

Study details: This retrospective study assessed palliative management in 67 patients with LAPC or MPC.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Choi CCM et al. ANZ J Surg. 2021 Apr 18. doi: 10.1111/ans.16669.

Key clinical point: Although locally advanced pancreatic cancer (LAPC) or metastatic pancreatic cancer (MPC) is associated with reduced exocrine function, there is a lack of clear guidelines for the diagnosis and management of exocrine pancreatic insufficiency (EPI) for palliative pancreatic ductal adenocarcinomas.

Major finding: Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively. Median body mass index decreased by 13.3% from preillness state to cancer diagnosis. Despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. Pancrelipase dose varied from 10,000 to 50,000 units with each meal.

Study details: This retrospective study assessed palliative management in 67 patients with LAPC or MPC.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Choi CCM et al. ANZ J Surg. 2021 Apr 18. doi: 10.1111/ans.16669.

Key clinical point: Patients with vs. without exocrine pancreatic insufficiency (EPI) had increased fasting breath hydrogen concentration (FBHC) levels, possibly because of the presence of hydrogen-producing genus Clostridium in the gut. FBHC may have a good potential as a simple test for EPI diagnosis.

Major finding: FBHC levels were significantly higher in the EPI vs. non-EPI (median, 15.70 ppm vs. 2.80 ppm; P less than .001) group and negatively correlated with p-aminobenzoic acid (PABA) excretion rate  (r, −0.523; P less than .001). The occupancy by Clostridia bacteria in intestinal bacterial flora was higher in EPI group (P less than .05).

Study details: This prospective study included 60 inpatients with pancreatic disease who underwent FBHC measurement, N-benzoyl-L-tyrosyl-PABA testing, and microbiome analysis. The PABA excretion rate of 73.4% classified patients into EPI (n=30) and non-EPI (n=30) groups.

Disclosures: No funding was obtained for this study. The authors declared no conflicts of interest.

Source: Uetsuki K et al. BMC Gastroenterol. 2021 May 10. doi: 10.1186/s12876-021-01776-8.

Key clinical point: Patients with vs. without exocrine pancreatic insufficiency (EPI) had increased fasting breath hydrogen concentration (FBHC) levels, possibly because of the presence of hydrogen-producing genus Clostridium in the gut. FBHC may have a good potential as a simple test for EPI diagnosis.

Major finding: FBHC levels were significantly higher in the EPI vs. non-EPI (median, 15.70 ppm vs. 2.80 ppm; P less than .001) group and negatively correlated with p-aminobenzoic acid (PABA) excretion rate  (r, −0.523; P less than .001). The occupancy by Clostridia bacteria in intestinal bacterial flora was higher in EPI group (P less than .05).

Study details: This prospective study included 60 inpatients with pancreatic disease who underwent FBHC measurement, N-benzoyl-L-tyrosyl-PABA testing, and microbiome analysis. The PABA excretion rate of 73.4% classified patients into EPI (n=30) and non-EPI (n=30) groups.

Disclosures: No funding was obtained for this study. The authors declared no conflicts of interest.

Source: Uetsuki K et al. BMC Gastroenterol. 2021 May 10. doi: 10.1186/s12876-021-01776-8.

Key clinical point: Patients with vs. without exocrine pancreatic insufficiency (EPI) had increased fasting breath hydrogen concentration (FBHC) levels, possibly because of the presence of hydrogen-producing genus Clostridium in the gut. FBHC may have a good potential as a simple test for EPI diagnosis.

Major finding: FBHC levels were significantly higher in the EPI vs. non-EPI (median, 15.70 ppm vs. 2.80 ppm; P less than .001) group and negatively correlated with p-aminobenzoic acid (PABA) excretion rate  (r, −0.523; P less than .001). The occupancy by Clostridia bacteria in intestinal bacterial flora was higher in EPI group (P less than .05).

Study details: This prospective study included 60 inpatients with pancreatic disease who underwent FBHC measurement, N-benzoyl-L-tyrosyl-PABA testing, and microbiome analysis. The PABA excretion rate of 73.4% classified patients into EPI (n=30) and non-EPI (n=30) groups.

Disclosures: No funding was obtained for this study. The authors declared no conflicts of interest.

Source: Uetsuki K et al. BMC Gastroenterol. 2021 May 10. doi: 10.1186/s12876-021-01776-8.

Key clinical point: Lumacaftor-ivacaftor treatment for 120 weeks improved exocrine pancreatic insufficiency and pancreatic damage in children as young as 2-5 years of age with cystic fibrosis (CF) homozygous for F508del-CF transmembrane conductance regulator gene.

Major finding: At baseline, 100% of participants had fecal elastase-1 (FE-1) less than 200 µg/g, of which 41 participants had FE-1 less than 15 µg/g. Treatment with lumacaftor-ivacaftor increased FE-1 (mean absolute change [D], 132.6±174.2 µg/g) and decreased immunoreactive trypsinogen (D, −108.5±306.6 ng/mL) from baseline to 120 weeks.

Study details: This phase 3 rollover trial (study 116) included 57 children with CF who completed 24 weeks of lumacaftor-ivacaftor treatment in previous study 115. Patients received weight- and age-based doses of lumacaftor-ivacaftor for additional 96 weeks, totaling 120 weeks of treatment.

Disclosures: This study was funded by Vertex Pharmaceuticals Incorporated (VPI). VPI was funded by CF Foundation for lumacaftor development. Some investigators including the lead author reported ties with VPI and CF Foundation.

Source: Hoppe JE et al. Lancet Respir Med. 2021 May 6. doi: 10.1016/S2213-2600(21)00069-2.

Key clinical point: Lumacaftor-ivacaftor treatment for 120 weeks improved exocrine pancreatic insufficiency and pancreatic damage in children as young as 2-5 years of age with cystic fibrosis (CF) homozygous for F508del-CF transmembrane conductance regulator gene.

Major finding: At baseline, 100% of participants had fecal elastase-1 (FE-1) less than 200 µg/g, of which 41 participants had FE-1 less than 15 µg/g. Treatment with lumacaftor-ivacaftor increased FE-1 (mean absolute change [D], 132.6±174.2 µg/g) and decreased immunoreactive trypsinogen (D, −108.5±306.6 ng/mL) from baseline to 120 weeks.

Study details: This phase 3 rollover trial (study 116) included 57 children with CF who completed 24 weeks of lumacaftor-ivacaftor treatment in previous study 115. Patients received weight- and age-based doses of lumacaftor-ivacaftor for additional 96 weeks, totaling 120 weeks of treatment.

Disclosures: This study was funded by Vertex Pharmaceuticals Incorporated (VPI). VPI was funded by CF Foundation for lumacaftor development. Some investigators including the lead author reported ties with VPI and CF Foundation.

Source: Hoppe JE et al. Lancet Respir Med. 2021 May 6. doi: 10.1016/S2213-2600(21)00069-2.

Key clinical point: Lumacaftor-ivacaftor treatment for 120 weeks improved exocrine pancreatic insufficiency and pancreatic damage in children as young as 2-5 years of age with cystic fibrosis (CF) homozygous for F508del-CF transmembrane conductance regulator gene.

Major finding: At baseline, 100% of participants had fecal elastase-1 (FE-1) less than 200 µg/g, of which 41 participants had FE-1 less than 15 µg/g. Treatment with lumacaftor-ivacaftor increased FE-1 (mean absolute change [D], 132.6±174.2 µg/g) and decreased immunoreactive trypsinogen (D, −108.5±306.6 ng/mL) from baseline to 120 weeks.

Study details: This phase 3 rollover trial (study 116) included 57 children with CF who completed 24 weeks of lumacaftor-ivacaftor treatment in previous study 115. Patients received weight- and age-based doses of lumacaftor-ivacaftor for additional 96 weeks, totaling 120 weeks of treatment.

Disclosures: This study was funded by Vertex Pharmaceuticals Incorporated (VPI). VPI was funded by CF Foundation for lumacaftor development. Some investigators including the lead author reported ties with VPI and CF Foundation.

Source: Hoppe JE et al. Lancet Respir Med. 2021 May 6. doi: 10.1016/S2213-2600(21)00069-2.

Interestingly the authors propose possible causative mechanisms. They note that normal pancreatic secretion is regulated by neural and endocrine control mechanisms that require intact gastro-pancreatico-duodenal anatomy. Disruptions to this include “extensive pancreatic denervation because of lymph node dissection and truncal vagotomy, the asynchronous release of pancreatic enzymes for food particles (pancreaticocibal-asynchrony) because of newly made reconstructions, and gastric reservoir and neural gastric stimulation losses.” They also include the possibility of effects of adjuvant therapies as well. 

While 64% of this patient population had some form of EPI, another study from this month’s selection by Sridhar et al out of Vellore, India tells a different story. In this cross-sectional study, they looked at symptomatic and biochemical evidence of EPI on pre and post questionnaires following gastric resection for adenocarcinoma. Of 27 patients that completed pre and post questionnaires, none of the patients on short-term follow-up (mean follow up of 3 months) had clinical symptoms of EPI following gastric resection. However, more than a third of the patients developed asymptomatic EPI after gastric resection, based on FE testing. The authors conclude that pancreatic supplementation might not be necessary following gastric resection, but perhaps their follow up window was much too short to draw such a conclusion. 

Interestingly the authors propose possible causative mechanisms. They note that normal pancreatic secretion is regulated by neural and endocrine control mechanisms that require intact gastro-pancreatico-duodenal anatomy. Disruptions to this include “extensive pancreatic denervation because of lymph node dissection and truncal vagotomy, the asynchronous release of pancreatic enzymes for food particles (pancreaticocibal-asynchrony) because of newly made reconstructions, and gastric reservoir and neural gastric stimulation losses.” They also include the possibility of effects of adjuvant therapies as well. 

While 64% of this patient population had some form of EPI, another study from this month’s selection by Sridhar et al out of Vellore, India tells a different story. In this cross-sectional study, they looked at symptomatic and biochemical evidence of EPI on pre and post questionnaires following gastric resection for adenocarcinoma. Of 27 patients that completed pre and post questionnaires, none of the patients on short-term follow-up (mean follow up of 3 months) had clinical symptoms of EPI following gastric resection. However, more than a third of the patients developed asymptomatic EPI after gastric resection, based on FE testing. The authors conclude that pancreatic supplementation might not be necessary following gastric resection, but perhaps their follow up window was much too short to draw such a conclusion. 

Interestingly the authors propose possible causative mechanisms. They note that normal pancreatic secretion is regulated by neural and endocrine control mechanisms that require intact gastro-pancreatico-duodenal anatomy. Disruptions to this include “extensive pancreatic denervation because of lymph node dissection and truncal vagotomy, the asynchronous release of pancreatic enzymes for food particles (pancreaticocibal-asynchrony) because of newly made reconstructions, and gastric reservoir and neural gastric stimulation losses.” They also include the possibility of effects of adjuvant therapies as well. 

While 64% of this patient population had some form of EPI, another study from this month’s selection by Sridhar et al out of Vellore, India tells a different story. In this cross-sectional study, they looked at symptomatic and biochemical evidence of EPI on pre and post questionnaires following gastric resection for adenocarcinoma. Of 27 patients that completed pre and post questionnaires, none of the patients on short-term follow-up (mean follow up of 3 months) had clinical symptoms of EPI following gastric resection. However, more than a third of the patients developed asymptomatic EPI after gastric resection, based on FE testing. The authors conclude that pancreatic supplementation might not be necessary following gastric resection, but perhaps their follow up window was much too short to draw such a conclusion. 

Key clinical point: The clinical presentation of exocrine pancreatic insufficiency (EPI) is probably mild in the early postoperative period following gastric resectional surgery. Thus, routine pancreatic supplementation may not be needed after surgery; however, worsening of EPI symptoms should be carefully monitored.

Major finding: During a mean follow-up of 3 months, none of the patients developed clinically significant steatorrhoea or fat malabsorption in postoperative setting. Incidence of EPI (fecal elastase less than 200 μg/g) following gastric resectional surgery was 33.3%.

Study details: This prospective study included 60 patients who received total or subtotal gastrectomy for adenocarcinoma of the stomach. Pre- and postoperative FE testing was done in 27 patients.

Disclosures: This study was funded by the Internal Fluid research Grant, Christian Medical College, Vellore, India. The authors declared no conflicts of interest.

Source: Sridhar RP et al. Indian J Surg Oncol. 2021 Apr 5. doi: 10.1007/s13193-021-01315-7.

Key clinical point: The clinical presentation of exocrine pancreatic insufficiency (EPI) is probably mild in the early postoperative period following gastric resectional surgery. Thus, routine pancreatic supplementation may not be needed after surgery; however, worsening of EPI symptoms should be carefully monitored.

Major finding: During a mean follow-up of 3 months, none of the patients developed clinically significant steatorrhoea or fat malabsorption in postoperative setting. Incidence of EPI (fecal elastase less than 200 μg/g) following gastric resectional surgery was 33.3%.

Study details: This prospective study included 60 patients who received total or subtotal gastrectomy for adenocarcinoma of the stomach. Pre- and postoperative FE testing was done in 27 patients.

Disclosures: This study was funded by the Internal Fluid research Grant, Christian Medical College, Vellore, India. The authors declared no conflicts of interest.

Source: Sridhar RP et al. Indian J Surg Oncol. 2021 Apr 5. doi: 10.1007/s13193-021-01315-7.

Key clinical point: The clinical presentation of exocrine pancreatic insufficiency (EPI) is probably mild in the early postoperative period following gastric resectional surgery. Thus, routine pancreatic supplementation may not be needed after surgery; however, worsening of EPI symptoms should be carefully monitored.

Major finding: During a mean follow-up of 3 months, none of the patients developed clinically significant steatorrhoea or fat malabsorption in postoperative setting. Incidence of EPI (fecal elastase less than 200 μg/g) following gastric resectional surgery was 33.3%.

Study details: This prospective study included 60 patients who received total or subtotal gastrectomy for adenocarcinoma of the stomach. Pre- and postoperative FE testing was done in 27 patients.

Disclosures: This study was funded by the Internal Fluid research Grant, Christian Medical College, Vellore, India. The authors declared no conflicts of interest.

Source: Sridhar RP et al. Indian J Surg Oncol. 2021 Apr 5. doi: 10.1007/s13193-021-01315-7.

Key clinical point: Exogenous digestive enzyme replacement was associated with increased weight gain and head circumference growth in very low birth weight preterm infants with growth failure and signs and symptoms of exocrine pancreatic insufficiency (EPI).

Major finding: Average daily weight gain increased from 14.4 g/kg/day to 17.4 g/kg/day (P = .001) and head circumference growth rate increased from 0.74 cm/week to 0.95 cm/week (P = .028) during 2 weeks following administration of digestive enzyme replacement.

Study details: This was a retrospective study of 132 preterm infants with gestational age below 2 weeks and birth weight below 1250 g who survived for more than 14 days. Growth restriction despite intensified nutrition and poor exocrine pancreatic function was observed in 66 and 38 infants, respectively, of which 33 infants recieved exogenous digestive enzyme replacement.

Disclosures: No specific funding source was identified. Open Access was funded by ProjektDEAL. The authors declared no conflicts of interest.

Source: Münch A et al. Eur J Pediatr. 2021 Apr 10. doi: 10.1007/s00431-021-04069-0.

Key clinical point: Exogenous digestive enzyme replacement was associated with increased weight gain and head circumference growth in very low birth weight preterm infants with growth failure and signs and symptoms of exocrine pancreatic insufficiency (EPI).

Major finding: Average daily weight gain increased from 14.4 g/kg/day to 17.4 g/kg/day (P = .001) and head circumference growth rate increased from 0.74 cm/week to 0.95 cm/week (P = .028) during 2 weeks following administration of digestive enzyme replacement.

Study details: This was a retrospective study of 132 preterm infants with gestational age below 2 weeks and birth weight below 1250 g who survived for more than 14 days. Growth restriction despite intensified nutrition and poor exocrine pancreatic function was observed in 66 and 38 infants, respectively, of which 33 infants recieved exogenous digestive enzyme replacement.

Disclosures: No specific funding source was identified. Open Access was funded by ProjektDEAL. The authors declared no conflicts of interest.

Source: Münch A et al. Eur J Pediatr. 2021 Apr 10. doi: 10.1007/s00431-021-04069-0.

Key clinical point: Exogenous digestive enzyme replacement was associated with increased weight gain and head circumference growth in very low birth weight preterm infants with growth failure and signs and symptoms of exocrine pancreatic insufficiency (EPI).

Major finding: Average daily weight gain increased from 14.4 g/kg/day to 17.4 g/kg/day (P = .001) and head circumference growth rate increased from 0.74 cm/week to 0.95 cm/week (P = .028) during 2 weeks following administration of digestive enzyme replacement.

Study details: This was a retrospective study of 132 preterm infants with gestational age below 2 weeks and birth weight below 1250 g who survived for more than 14 days. Growth restriction despite intensified nutrition and poor exocrine pancreatic function was observed in 66 and 38 infants, respectively, of which 33 infants recieved exogenous digestive enzyme replacement.

Disclosures: No specific funding source was identified. Open Access was funded by ProjektDEAL. The authors declared no conflicts of interest.

Source: Münch A et al. Eur J Pediatr. 2021 Apr 10. doi: 10.1007/s00431-021-04069-0.

Key clinical point: Exocrine pancreatic function appeared normal in critically ill children during the first week of admission to the pediatric intensive care unit (PICU).

Major finding: Fecal elastase-1 concentrations were normal (1-2 μg/g; n=10). Mean amylase levels on admission and PICU discharge were 13 (interquartile range [IQR], 6.5-41.5) U/L and 15.5 (IQR, 7-44) U/L, respectively. Mean lipase levels on admission and at PICU discharge were 11 (IQR, 6.8-19.5) U/L and 16.5 (IQR, 12.3-36.8) U/L, respectively.

Study details: Findings are from a prospective observational study that included 15 critically ill children (median age, 5 months) admitted to PICU (median stay, 15 days) at a tertiary hospital in Madrid, Spain.

Disclosures: No specific funding source was identified. The authors did not report any disclosures.

Source: Solana Garcia MJ et al. Pedia Crit Care Med. 2021 Mar doi: 10.1097/01.pcc.0000738960.34833.ce.

Key clinical point: Exocrine pancreatic function appeared normal in critically ill children during the first week of admission to the pediatric intensive care unit (PICU).

Major finding: Fecal elastase-1 concentrations were normal (1-2 μg/g; n=10). Mean amylase levels on admission and PICU discharge were 13 (interquartile range [IQR], 6.5-41.5) U/L and 15.5 (IQR, 7-44) U/L, respectively. Mean lipase levels on admission and at PICU discharge were 11 (IQR, 6.8-19.5) U/L and 16.5 (IQR, 12.3-36.8) U/L, respectively.

Study details: Findings are from a prospective observational study that included 15 critically ill children (median age, 5 months) admitted to PICU (median stay, 15 days) at a tertiary hospital in Madrid, Spain.

Disclosures: No specific funding source was identified. The authors did not report any disclosures.

Source: Solana Garcia MJ et al. Pedia Crit Care Med. 2021 Mar doi: 10.1097/01.pcc.0000738960.34833.ce.

Key clinical point: Exocrine pancreatic function appeared normal in critically ill children during the first week of admission to the pediatric intensive care unit (PICU).

Major finding: Fecal elastase-1 concentrations were normal (1-2 μg/g; n=10). Mean amylase levels on admission and PICU discharge were 13 (interquartile range [IQR], 6.5-41.5) U/L and 15.5 (IQR, 7-44) U/L, respectively. Mean lipase levels on admission and at PICU discharge were 11 (IQR, 6.8-19.5) U/L and 16.5 (IQR, 12.3-36.8) U/L, respectively.

Study details: Findings are from a prospective observational study that included 15 critically ill children (median age, 5 months) admitted to PICU (median stay, 15 days) at a tertiary hospital in Madrid, Spain.

Disclosures: No specific funding source was identified. The authors did not report any disclosures.

Source: Solana Garcia MJ et al. Pedia Crit Care Med. 2021 Mar doi: 10.1097/01.pcc.0000738960.34833.ce.